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Behavioural observation audiometry in testing young hearing-impaired children
J O Karikoski1, T I Marttila, T Jauhiainen
1Department of Audiology, Ear, Nose and Throat Clinic, Helsinki University Central Hospital, Finland.
Insights
Behavioral observation audiometry (BOA) shows variable accuracy in predicting hearing acuity in children. While useful for mild losses, BOA may overestimate hearing in severe cases, requiring careful interpretation alongside pure-tone audiometry.
Area of Science:
- Audiology
- Pediatric audiology
- Hearing assessment
Background:
- Accurate hearing assessment in children is crucial for early intervention.
- Behavioral observation audiometry (BOA) is a common, non-behavioral audiological test for infants and young children.
- The predictive accuracy and frequency-specific validity of unconditioned BOA require further investigation.
Purpose of the Study:
- To evaluate the accuracy of unconditioned behavioral observation audiometry (BOA) in predicting hearing acuity in children.
- To determine the validity of BOA test results across various frequencies.
- To compare BOA outcomes with established pure-tone audiometry thresholds.
Main Methods:
- Longitudinal comparison of BOA response levels (age >12 months) with pure-tone thresholds in 119 children.
- Subjects were selected from a larger cohort of 353 children fitted with hearing aids.
- Analysis of BOA predictive power based on hearing loss severity and frequency.
Main Results:
- BOA accuracy is dependent on hearing loss severity.
- At 30-39 dB hearing level, BOA underestimated hearing by 10-15 dB compared to pure-tone audiometry.
- BOA results correlated significantly with pure-tone thresholds (r = 0.71, p = 0.000) from 0.5 to 4 kHz.
- In severe impairments (>70 dB HL), BOA tended to overestimate hearing acuity.
Conclusions:
- BOA can be a useful screening tool, but its predictive accuracy varies with hearing loss severity.
- BOA averages of ≤30 dB rarely indicate hearing loss requiring hearing aid fitting.
- Results suggest BOA should be interpreted cautiously, especially in cases of suspected severe hearing impairment, and complemented by pure-tone audiometry.
Abstract:
The aim was to examine the accuracy of unconditioned behavioural observation audiometry (BOA) in predicting hearing acuity in children and the validity of test results at various frequencies. The study was designed to longitudinally compare each child's best BOA response level (at the age >12 months) with the conclusive pure-tone threshold of the better ear. The subjects were 119 children derived from a material of 353 children fitted with a hearing aid at Helsinki University Central Hospital. BOA was carried out on 119 children, 19 of whom did not respond to frequency-specific stimuli. The predictive power of BOA depended on the severity of hearing loss. At the hearing level of 30-39 dB, BOA registered 10-15 dB poorer levels than the pure-tone audiometry. The pure-tone averages (0.5, 1, 2 kHz) of 50-69 dB agreed best with the BOA responses. In severe impairments (more than 70 dB HL), the BOA registered too good hearing. Correlation of the results from the two modes to measure hearing level was highly significant (r = 0.71, p = 0.000), and the pure-tone hearing level agreed with that of BOA at the frequencies 0.5 to 4 kHz. Our results show that BOA averages < or =30 dB rarely indicate hearing loss demanding fitting of a hearing aid.
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